Healthcare Provider Details

I. General information

NPI: 1164689865
Provider Name (Legal Business Name): LOURDES H BEAUZILE-DELIMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
AGAWAM MA
01001-1838
US

IV. Provider business mailing address

230 MAIN ST
AGAWAM MA
01001-1838
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-6800
  • Fax: 413-789-5171
Mailing address:
  • Phone: 413-789-6800
  • Fax: 413-789-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number245338
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: